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Author Topic: Chronic Arthritis Problems in a 36 year old Knee  (Read 2689 times)

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Offline Dave777

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Chronic Arthritis Problems in a 36 year old Knee
« on: January 11, 2006, 03:28:26 AM »
Hello,
I am a 36 year chronic knee patient and occasionally lurk onto this site as my time permitts. I injured my Right Knee around 12 years ago and had Partial Lateral Menisectomy around 7 years ago. It was doing OK for some time, but since the last 18 months, I am having horrible time and pain either walking or standing. I have been seeing some of the top sports doctors in Bay Area and they do not provide much info on what might help me in getting my knee better. They just advise me to do therapy and do not spend much time discussing my pain. I had an MRI from June, 2004 and they never bother to educate me on the level of Arthritis in my knee. For me it seems like it is very severe based on my pain and the the MRI scan results.

Please find below a brief synopsys of the MRI report. Can some one interpret this for me and advise me what level of Arthritis I have and whether OATS procedure/Arthroscopy/Cortizone/Hyalunin shots would help me. (Fyi: I just had another MRI a week ago and to be honest I never seen a crappy MRI report like that before. It is all latin and greek like a high school essay. I could not even understand a piece of it). If you can not understand the latest MRI report, please read my earlier MRI report which is also attached.

I have couple of questions:

1) Would an arthroscopy help to diagnose the problem and fix any of my symptoms.
2) What is the success rate of OATS rocedure and long term results?
3) If I need to go for OATS,who is the best OS in bay area.
4) Should I be trying cortizone/Hyalun shots before I try any surgery?

I have an appt tomorrow for MRI follow up with my OS and any insghts would be helpful.


Right Knee MRI Report from Jan' 2006 (with Contrast Gladium Arsenide):
---------------------------------------------------------------------------------------------------


Summary (AS IS):

1) Diffuse Prominent enhancement of the distal short head of the bicepal femoris with a very small aount of perifascial fluid. This was not present in the previous study. This is of uncertai etiology but doesn't have a classic strain appearance but could be related to a resolving muscle strain. Alternatively would consider early denervation change although atypical pattern and this would have to involve an isolated branch of the sciatric nerve.

2)Focal vey Limited peripheral inferior leaflet tear posterior horn/body junction medical meniscus with associated mild enhancement and there is adjacent loculated fluid in the meniscotibial recess dissecting deep to the pes tendons posteromedial join line. Present previously.

3)Shallow contour changes free edge body/anterior horn junction lateral meniscus which may be from meniscal trimming or extremely shallow tearing. No change in appearance.

4)No chondral defects

5)Minimal join fluid with no evidence of inflammation within the joint.

6)Minimal to mild anterior interval scarring associated with prior surgery.

7) Very Small popliteal cyst


RIGHT KNEE MRI Scan Results June 2004:
--------------------------------------------------------------



BONES:
--------
subchondral edema at the base of the lateral component of tibial spine
mild spurring of lateral femoral compartment as well as tibial spine (degenerative changes)

CARTILLAGE:
-----------

SIGNIFICANT THINNING OF ARTICULAR CARTILLAGE OVERLYING LATERAL TIBIAL PLATEAU
ALSO ABNORMAL SIGNAL WITHIN VISUALIZED CARTILLAGE OF LATERAL TIBIAL PLATEAU (DEGENERATIVE CHANGE)
REMAINING CARTILLAGE INLCUDING PATELLOFEMORAL CARTILLAGE IS UNREMARKABLE


MENISCI
--------

ABNORMAL SIGNAL IN MIDPORTION OF ANTERIOR HORN OF LATERAL MENISCUS,
ABNORMAL SIGNAL EXTENDS INTO SUPERIOR ARTICULAR SURFACE. (DEGENERATIVE TEAR)


POSTERIOR HORN OF LATERAL MENISCUS IS NORMAL
MEDIAL MENISCUS IS NORMAL

EXTENSOR MECHANISM:
-----------------

A LIGAMENTOUS MUCOSA IS PRESENT

MISC:
-----

1.5 x 1 x 2,9 Baker's Cyst is Present

EFFUSION
--------

minimal amunt of intrapatellar bursial fluid. also present in sprapatellar lateral recess


LIGAMENTS
---------
OK

IMPRESSION:
-----------------

1) DEGENERATIVE TEAR OF THE ANTERIOR HORN OF LATERAL MENISCUS EXTENDING TO SUPERIOR ARTICULAR SURFACE AT MIDPORTION
2) CHRONDOMALACIA WITH SPURRING AD SUBCHONDRAL EDEMA OF LATERAL COMPARTMENT OF KNEE
3) SMALL BAKER'S CYST



Thanks in advance for reading my story and any advises that will be life saver for me.

Dave
July 1993 - Right Knee Injury
Dec 1998 - R Partial Lateral  Mensiectomy
                Grade 3 Lateral Tbiail Chondral INjury
Aug 2000 - L Chondroplasty / LR
2000 - 2003 - Multiple MRI / Therapy
June 2004 - MRI shows thinning of articular cartillage
                  in lateral tibial platea

Offline blackbeltgirl

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Re: Chronic Arthritis Problems in a 36 year old Knee
« Reply #1 on: January 11, 2006, 01:21:56 PM »
I'm confused.  One report says no chondral changes - meaning no damage to articular cartilage.  The other says thinning of articular cartilage to tibial plateau.

It sounds like you need to become an educated patient.  First - request a written copy of all medical and surgical records.  You mentioned prior arthoscopies - if those reports are still available (facilities are only required to store records for 7 years I think) they should mention any lesions found, and the size of the lesions.

Second - start learning about articular cartilage health and treament.  In addition to this site, I like cartilagedoc.org.  Go to the resources section, then knee.  Depending on the details of your damage, you may be a candidate for microfracture, OATS, allograft plugs, or ACI.  If the knee is causing you this much pain, and your current OS isn't interested in helping you resolve it, it's time to find a new OS.  Look for someone who specializes in cartilage restoration/repairs. 

Here's a post from Janice (user name JG) on some CA doctors.
Lori,

Check out this site from Dr. William Bugbee:  http://medicine.ucsd.edu/ortho/procedures/allografting.shtml

He is in San Diego.  If you are in the SoCal area, he is the guy to see.  Mandelbaum is an ACI expert I think (my OS Dr. Thabit doesn't do ACI and recommended Mandelbaum if I wanted to persue that option).

Other than that, two other surgeons to consider seeing would be Dr. Brian Cole in Chicago and Dr. Minas in Boston.  They really specialize in the salvage procedures.  Dr. Thabit is more of a generalist, but has a subfocus on arthitis and doesn't do all the procedures such as ACI.

Janice

Good luck with your self-educating and self-advocating.
Jess
ACI was supposed to be 2/21/06.  On 6/29/06 Insurance co said have another scope, and if it still looks good, they'll ok the ACI.
Microfracture Dec 7, 2004
   3cm x 6cm lesion, LFC; 3cm x 1cm lesion, trochlear groove; lateral tibial plateau lesion
2nd degree black belt, tae kwon do (had to stop)

Offline Dave777

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Re: Chronic Arthritis Problems in a 36 year old Knee
« Reply #2 on: January 12, 2006, 04:07:37 AM »
Thanks Jess,

What is confusing is that my OS said that the recent MRI showed some dead tissue in knee and hence we wants to do an EMG(ElectoMyoGraph), also called as Nerve Conduction Test. He said this is not related to my pain, but we need to get this tested to rule out any nerve injury. I never heard this before and now I am totally confused with an EMG on a knee. He however said the MRI did not say any thing about Arthritis and he does not see much in the films either. I am totally confused now.

Have you ever heard of EMG on a knee ?

btw, I have all my surgery reports and the Menisectomy surgery report said there is a 10X10 cm chondral lesion in right lateral tibial plateau. When I asked the surgeon about the possibility of fixing this, he said that he does not see that much lesion in the MRI film.








I'm confused.  One report says no chondral changes - meaning no damage to articular cartilage.  The other says thinning of articular cartilage to tibial plateau.

It sounds like you need to become an educated patient.  First - request a written copy of all medical and surgical records.  You mentioned prior arthoscopies - if those reports are still available (facilities are only required to store records for 7 years I think) they should mention any lesions found, and the size of the lesions.

Second - start learning about articular cartilage health and treament.  In addition to this site, I like cartilagedoc.org.  Go to the resources section, then knee.  Depending on the details of your damage, you may be a candidate for microfracture, OATS, allograft plugs, or ACI.  If the knee is causing you this much pain, and your current OS isn't interested in helping you resolve it, it's time to find a new OS.  Look for someone who specializes in cartilage restoration/repairs. 

Here's a post from Janice (user name JG) on some CA doctors.
Lori,

Check out this site from Dr. William Bugbee:  http://medicine.ucsd.edu/ortho/procedures/allografting.shtml

He is in San Diego.  If you are in the SoCal area, he is the guy to see.  Mandelbaum is an ACI expert I think (my OS Dr. Thabit doesn't do ACI and recommended Mandelbaum if I wanted to persue that option).

Other than that, two other surgeons to consider seeing would be Dr. Brian Cole in Chicago and Dr. Minas in Boston.  They really specialize in the salvage procedures.  Dr. Thabit is more of a generalist, but has a subfocus on arthitis and doesn't do all the procedures such as ACI.

Janice

Good luck with your self-educating and self-advocating.
Jess
Quote
July 1993 - Right Knee Injury
Dec 1998 - R Partial Lateral  Mensiectomy
                Grade 3 Lateral Tbiail Chondral INjury
Aug 2000 - L Chondroplasty / LR
2000 - 2003 - Multiple MRI / Therapy
June 2004 - MRI shows thinning of articular cartillage
                  in lateral tibial platea

Offline blackbeltgirl

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Re: Chronic Arthritis Problems in a 36 year old Knee
« Reply #3 on: January 12, 2006, 01:07:41 PM »
Dave -

I've never heard of an EMG, so I can't help you there.

MRIs are intended to show soft tissue - ligaments, tendons, etc.  They do a poor job of showing articular cartilage, so to discount an actual visual from a surgical report, in place of an MRI image makes no sense to me.  That said - the entire tibial platea is not 10cm wide and probably not 10cm long either, so I can't see how your lesion could be 10cm x 10cm.  It could be 10mm x 10mm, maybe it was a typo.  10cm is about 4 inches.

Did the OS say what kind of dead tissue he sees?  Or where it's located?  You've got me stumped.  Dead articular cartilage is called ostechondral dissecans (I think), and if the bone dies first, killing the cartilage I think it's called AVN - don't ask me what that stands for.  But you will find it if you look in the glossary section on the main page.  I'm sure there are a variety of other possibilities, but I'm stumped.  As long as you have confidence in this OS, keep up the effort to find the cause of your pain.  But stay informed - don't let him explain a diagnosis without giving you the specific medical terms so you can do your own research.  And if you're not so confident, make an appointment for a 2nd opinion.

Good luck-
Jess
ACI was supposed to be 2/21/06.  On 6/29/06 Insurance co said have another scope, and if it still looks good, they'll ok the ACI.
Microfracture Dec 7, 2004
   3cm x 6cm lesion, LFC; 3cm x 1cm lesion, trochlear groove; lateral tibial plateau lesion
2nd degree black belt, tae kwon do (had to stop)

Offline JG

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Re: Chronic Arthritis Problems in a 36 year old Knee
« Reply #4 on: January 13, 2006, 08:18:05 AM »
Dave,

I've had a few EMG's but they aren't really knee specific.  An EMG measures a muscles response to nerve stimulation.  They use small needles inserted into your muscles to detect the nerves reaction to muscle contraction.  An EMG can help to distinguish primary muscle conditions from muscle weakness caused by neurologic disorders.

I tend to form lots of scar tissue.  It actually caused a problem with my common peroneal nerve to a point that I developed a slight drop foot and lost of sensation in my knee.  The scar tissue basically engulfed my common peroneal nerve at the bifrication point (splits into the superficial and deep at the fibular head).  They used both the EMG and nerve conduction test to determine what the problem was, where it was, how bad, etc..  I had the nerve decompressed in May.  It was pretty easy surgery.

Also, in my opinion MRIs are really not very helpful for cartilage problems.  My OS, in my case, just uses them to look at the underlying bone structure and health rather than the articular cartilage.  Trust me, my very original MRI was normal except one focal lesion they knew had to be there because I had synovial fluid that seeped up a fracture in my LFC.  However, when he scoped me, I had Grade IV arthritis in all three compartments.  Go figure.

Janice
Sept-99 - L knee LR
Aug-02 - L knee LR/menisectomy
Apr-03 - L Knee Mosaicplasty Using Allograft (18 grafts)/LR/debridement/menisectomy; Right Knee menisectomy.
Apr-04 - L Scope - LR/Lysis Adhesions

Offline stgiles16

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Re: Chronic Arthritis Problems in a 36 year old Knee
« Reply #5 on: January 13, 2006, 11:31:52 AM »
AVN=Avascular Necrosis. bone death.

As for MRIs, none of my MRIs have shown my articular cart. damage so I dont have any faith in them where chondral defects are concerned. I agree with Jess, I would get a second opinion.
good luck
missy
2 ligament recons right ankle
2 arthroscopic,
5 open knee procedures
2 Plica removals
bone spur removal
2 microfractures
4 debridements
2 open LOAs all on left knee
Arthritis,both knees, ankles, shoulders, elbows, hands,spine
Fibromyalgia
Arthrofibrosis
LOA & PKR 2/15/06
RA
in pain mgmt
TKR JAN 2012

Offline Dave777

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Re: Chronic Arthritis Problems in a 36 year old Knee
« Reply #6 on: January 13, 2006, 10:49:12 PM »
Hello JG,
I agree with your EMG knowledge. I was reading your posts and looks like we both are going to the same ortho group. My says MRI does not show much chondral defects. btw, my Lateral Tibila lesion is grade 3, but some how the previous serugeon wrote it as 10x10cm. I guess that was a typo. If you do not mind, Can I chat with you on ur personal e-mail address?

Thanks

Dave

July 1993 - Right Knee Injury
Dec 1998 - R Partial Lateral  Mensiectomy
                Grade 3 Lateral Tbiail Chondral INjury
Aug 2000 - L Chondroplasty / LR
2000 - 2003 - Multiple MRI / Therapy
June 2004 - MRI shows thinning of articular cartillage
                  in lateral tibial platea

Offline Dave777

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Re: Chronic Arthritis Problems in a 36 year old Knee
« Reply #7 on: January 13, 2006, 10:51:00 PM »
Hello Jess,
yes. You migh be wright. The surgerry report described lateral tibial lesion as Grade 3, but some how was written as 10x10 cm. What is the range for a Grade 3 lesion?

Thanks

Dave

July 1993 - Right Knee Injury
Dec 1998 - R Partial Lateral  Mensiectomy
                Grade 3 Lateral Tbiail Chondral INjury
Aug 2000 - L Chondroplasty / LR
2000 - 2003 - Multiple MRI / Therapy
June 2004 - MRI shows thinning of articular cartillage
                  in lateral tibial platea

Offline JG

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Re: Chronic Arthritis Problems in a 36 year old Knee
« Reply #8 on: January 16, 2006, 12:34:52 AM »
Dave,

Sure.  Are you going to SOAR?  Who is your OS?  They typically refer to the Physiatry Group (same location) to do the nerve stuff.  Is that what they did with you?  Please send me an email and I will get back to you with my phone number that might be easier.

Janice
Sept-99 - L knee LR
Aug-02 - L knee LR/menisectomy
Apr-03 - L Knee Mosaicplasty Using Allograft (18 grafts)/LR/debridement/menisectomy; Right Knee menisectomy.
Apr-04 - L Scope - LR/Lysis Adhesions

Offline blackbeltgirl

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Re: Chronic Arthritis Problems in a 36 year old Knee
« Reply #9 on: January 16, 2006, 12:48:16 AM »
Dave -

The grades of chondro are only partly about size.  They're mostly a bout the state of the cartilage.  You will find better descriptions of the scale in a number of other posts, but basically, grade 1 is soft cartilage.  Grade 2-3 is where it starts to break up and can look a little like crab meat.  Depending on how deep the lesion is, and the size, affects the grade.  Grade 4 means it's down to the bone, regardless of size.  Hope that helps.  The actual measurements can be tough to get without a scope, but if I remember correctly, yours come from a scope.  It may just be a typo, especially since your report specifically states lateral tibial plateau, meaning it's contained to one half of the tibial plateau.  Worth asking about, though.

Good luck with that EMG test.
Jess
ACI was supposed to be 2/21/06.  On 6/29/06 Insurance co said have another scope, and if it still looks good, they'll ok the ACI.
Microfracture Dec 7, 2004
   3cm x 6cm lesion, LFC; 3cm x 1cm lesion, trochlear groove; lateral tibial plateau lesion
2nd degree black belt, tae kwon do (had to stop)

Offline Dave777

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Re: Chronic Arthritis Problems in a 36 year old Knee
« Reply #10 on: January 18, 2006, 08:40:47 PM »
Thanks for all the replies. Those were really helpful and you guys are really grea. My OS was already saying to his associate that we should get some biopsy and bone scan on my knee. Biopsy did scare me. What exactly does a bone scan do? I want to buy some time before I can go for EMG as well.

I am now trying to self educate myself. I am reviewing all my surgery/MRI scan reports and trying to understand some of the terms. Where do I get information about different knee terms like Patello Femoral Lesion, Medial Condyle, Lateral Condyle, OCD, Lateral Tibial, Bursal Fluid etc. Quite honestly I feel that is the best way to go with the situation I am in.

Thanks in Advance...
July 1993 - Right Knee Injury
Dec 1998 - R Partial Lateral  Mensiectomy
                Grade 3 Lateral Tbiail Chondral INjury
Aug 2000 - L Chondroplasty / LR
2000 - 2003 - Multiple MRI / Therapy
June 2004 - MRI shows thinning of articular cartillage
                  in lateral tibial platea

Offline blackbeltgirl

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Re: Chronic Arthritis Problems in a 36 year old Knee
« Reply #11 on: January 18, 2006, 09:15:11 PM »
The main kneeguru page has a glossary, and you can learn about all those terms there.  If you want to learn about articular cartilage health and treatment options, there is some good info on the main page.  The classes on the main page are free, too, so you can learn more about the knee, overall.  And cartilagedoc.org is one of the websites I used in the self-education process.  Go to resources, and the knee section.  Towards the bottom of the page is an entire section of articles on cartilage health.

As to biopsy - he may mean a biopsy for carticel, or ACI.  In an arthroscopic procedure, they take a small sample of cells and send them to a lab.  If you need the procedure, the cells can be cultured, and they actually stick your own cartilage cells back in your knee to fill in the hole.  It's not quite as simple as that, but that may be what you're doctor is planning for.

Good luck-
Jess
ACI was supposed to be 2/21/06.  On 6/29/06 Insurance co said have another scope, and if it still looks good, they'll ok the ACI.
Microfracture Dec 7, 2004
   3cm x 6cm lesion, LFC; 3cm x 1cm lesion, trochlear groove; lateral tibial plateau lesion
2nd degree black belt, tae kwon do (had to stop)

Offline stgiles16

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Re: Chronic Arthritis Problems in a 36 year old Knee
« Reply #12 on: January 18, 2006, 09:16:59 PM »
Hi Dave, I might can help you with some of those definitions. If you cant understand my explanation, part of those terms refer to parts of the knee and you can see pictures of them on a diagram of the knee.

Patella Femoral lesion: well a lesion is like a pot hole in your articular cartilage. Patella femoral means that it is on the back of your patella (I am not sure about this one but that is my best guess)

Medial Chondyle : this one I know for sure. At the end of your femur (thigh bone) you bone ends with what looks like two knobs on the end of the bone with white shiny cartilage covering it (articular cart, looks kind of like a chicken leg bone) the medial is on the inside on the knee, closest to the other leg)
The lateral Chondyle is the outside "knob" on the end of the femur.
OCD: Osteochondral dissectans (or something similar) this is a condition that I beleive means that you have pot holes in the articular cart.

Lateral tibial refers to the outside of the tibia bone which is the shin bone.

Bursal fluid, well I know that the bursa are fluid filled sacks located in different places around the knee. Could they be referring to one of your bursa leaking?  

there is a dictionary on the main page of the website to look up any words that you dont understand.
good luck
missy
2 ligament recons right ankle
2 arthroscopic,
5 open knee procedures
2 Plica removals
bone spur removal
2 microfractures
4 debridements
2 open LOAs all on left knee
Arthritis,both knees, ankles, shoulders, elbows, hands,spine
Fibromyalgia
Arthrofibrosis
LOA & PKR 2/15/06
RA
in pain mgmt
TKR JAN 2012















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